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For example, a B 12 -deficient state which causes megaloblastic anemia and which may be mistaken for classical PA may be caused by infection with the tapeworm Diphyllobothrium latum , possibly due to the parasite's competition with host for vitamin B 12

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If a pregnant patient has a documented deficiency of one or more B vitamins or a condition like hyperemesis that prevents oral intake, the benefits of correcting the deficiency (preventing serious maternal and fetal complications) outweigh any minimal risk from the injection